Left: A man sifts through betel nuts in Pingtung County on Sept. 1.一名男子十月一日於屏東縣篩選檳榔

Photo: Yeh Yung-chien, Liberty Times照片：自由時報記者葉永騫

Over the past two decades, there has been an increase in the prevalence of esophageal cancer in Taiwan and the number of attributable deaths has also risen significantly. Doctors are ascribing the spike in cases and deaths to males smoking tobacco, drinking alcohol and chewing betel nuts. On Oct. 22, National Taiwan University Hospital’s (NTUH) Department of Thoracic Surgery established the Esophageal Cancer Association. They are urging people who might be at risk to receive checkups periodically.

Lee Chang-ming, head of NTUH’s Department of Thoracic Surgery, says that esophageal cancer typically occurs among males in their 50s and 60s. Esophageal cancer was sixth on a list of the top 10 most common cancer-related causes of death in Taiwan last year for males. The average age of people dying from the cancer has gradually fallen, decreasing from 64 in 2001 to 58 last year. The age of people dying from esophageal cancer can be as low as 25 to 29 years old. The youngest person that Lee ever treated for esophageal cancer was 31 years old, he says.

People are two to three times more likely to get esophageal cancer if they chew 10 betel nuts every day for 10 years, Lee says. The same goes for people who smoke a pack of cigarettes every day for 10 years. However, if that sort of risky behavior combines smoking cigarettes, drinking alcohol and chewing betel nuts, the chances of getting the cancer increase exponentially, meaning a person is 20 to 60 times more likely to get it. If you enjoy eating hot soup and pickled foods, which can be high in nitrosamines, a carcinogen, or if your esophagus has been damaged and you have a family history of esophageal cancer, you should get tested regularly.

Lee says that because it is difficult to detect the cancer at an early stage, it makes it necessary to use an upper gastrointestinal endoscopy for a diagnosis. Once symptoms, including difficulty breathing, pain and a hoarse, cracked voice appear, it means that the cancer has probably already progressed to the point where it would require surgery, chemotherapy and radiation therapy.